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Opioid crisis: New evidence shows how 'medication-assisted treatment' saves lives and money

·Senior Editor
·6-min read

America's opioid crisis has gotten worse over the last two decades, and a new study bolsters calls for medication-assisted treatment (MAT) to manage resulting substance use disorders.

MAT is defined by the Substance Abuse and Mental Health Services Administration (SAMHSA) as "the use of medications, in combination with counseling and behavioral therapies, to provide a 'whole-patient' approach to the treatment of substance use disorders."

And according to a recent study from the Journal of American Medical Association (JAMA) that analyzed a a cohort of 100,000 patients over 5 years, MAT therapy could be cost effective in addition to lowering the number of overdose deaths.

“When criminal justice costs were included, all forms of MAT (with buprenorphine, methadone, and naltrexone) were associated with cost savings compared with no treatment, yielding savings of $25,000 to $105,000 in lifetime costs per person,” the report stated.

WASHINGTON, DC - DECEMBER 09: Dr. Edwin C. Chapman, right center, sees patient, Stanley Holt, left, who is being treated with a medication that contains buprenorphine and naloxone on Tuesday December 09, 2014 in Washington, DC.  The medication is used for an addiction to opiates. (Photo by Matt McClain/ The Washington Post via Getty Images)
Dr. Edwin C. Chapman sees a patient who is being treated with a medication that contains buprenorphine and naloxone on December 9, 2014 in Washington, DC. (Photo by Matt McClain/ The Washington Post via Getty Images)

The results of the JAMA study came as no surprise to Sheila Vakharia, deputy director at the Drug Policy Alliance.

“Anyone who’s out there on the ground and seen this firsthand could tell you the cost effectiveness,” Vakharia told Yahoo Finance, noting that the study "adds to a broad base of evidence that shows the efficacy of these treatments."

So why is MAT not used more widely?

“There are many barriers, including lack of access, lack of training, and lack of political will,” Dr. Doug Owens, a professor at Stanford University and one of the co-authors of the report, told Yahoo Finance.

Both cost and death rates lowered

All forms of MAT saved money compared to providing no treatment at all since "individuals receiving treatment and individuals who become abstinent due to treatment have significantly lower criminal justice costs than untreated individuals with [opioid use disorder].”

Naltrexone saved roughly $40,000 in these costs, while buprenorphine saved $60,000 and methadone saved $100,000.

Methadone is a synthetic opioid agonist, meaning it acts on opioid receptors in the brain and eliminates withdrawal symptoms and relieves drug cravings. Buprenorphine is considered a partial opioid agonist, which means that it "binds to those same opioid receptors but activates them less strongly than full agonists do," according to the National Institute on Drug Abuse.

Tarryn Vick takes her dose of methadone where she is being treated for drug addiction at the Evergreen Treatment Services clinic in Hoquiam, Wash., Thursday, June 15, 2017. Grays Harbor County public health department last year collected 750,000 needles at its syringe exchange designed to stem the tide of disease, an incredible number for a small town, but still down from more than 900,000 the year before. They attribute that improvement to the methadone clinic that helps nearly 500 people stay off drugs. (AP Photo/David Goldman)
A woman takes her dose of methadone where she is being treated for drug addiction at the Evergreen Treatment Services clinic in Hoquiam, Wash. on June 15, 2017. (AP Photo/David Goldman)

Naltrexone, meanwhile, works a bit differently: The drug is an opioid antagonist, meaning that it prevents opioid receptors from being activated. While methadone and buprenorphine control withdrawal and cravings, naltrexone keeps the person from experiencing any type of euphoria from an opioid.

MAT with these medications and other treatment also led to fewer overdose deaths: JAMA found that MAT with methadone reduced deaths by 6% in the cohort while MAT with buprenorphine or naltrexone reduced mortality by 13.9%.

An estimated 87,000 Americans died from drug overdoses within the span of a year. (Chart: CDC)
Drug overdose deaths increased substantially through 2020. (Chart: CDC)

According to the most recent CDC data, overdose deaths increased by an estimated 28.8% for the 12-month period ending in September 2020, totaling more than 87,000. (Fentanyl, a synthetic opioid that can be 50 times stronger than heroin, is a major driver of overdose deaths.)

The coronavirus pandemic exacerbated the opioid overdose problem. 

The American Medical Association found that more than 40 states reported annual increases in opioid overdose deaths in 2020 while the pandemic also exacerbated “ongoing concerns for those with a mental illness or substance use disorder."

Drug overdose deaths are estimated to have increased by 28.8% for the 12-month period ending in September 2020. (Map: CDC)
Drug overdose deaths are estimated to have increased by 28.8% for the 12-month period ending in September 2020. (Map: CDC)

'There aren't enough medical providers to go around'

The Biden administration altered rules in order to make it easier for health care professionals to prescribe buprenorphine for drug addiction, though there are still obstacles to expanding MAT.

And once a medical professional is approved for providing buprenorphine, they can only prescribe the medication to 30 patients in the first year.

“That was seen as a huge step forward, although arguably still not far enough,” Vakharia said, explaining that most doctors see more than 30 patients on their caseload. “How are you going to keep track of only 30 patients, making sure that you've prescribed to the full list? There are plenty of... communities where there aren't enough medical providers to go around.”

Beyond basic bureaucratic challenges, there is also a lack of acceptance of MAT for opioids.

“I do think with opioid use disorder, there’s this mistaken belief that what you’re really doing is trading one drug for another, and then they don’t think of it as treating the disorder,” Bradley Stein, director of the RAND Opioid Policy Center, told Yahoo Finance. “When we think about treatment for other chronic disorders, we don’t go to people who have diabetes and say ‘you don’t need to be on your insulin’ or individuals who have hypertension and say ‘you don’t need to be on this medication to control your blood pressure.’ So I do think a lot of [the mistaken belief] really is the underlying cause.”

BOSTON, MA - APRIL 27: Dr. Laura Kehoe talks to a patient during his appointment as Mass. General Hospital in Boston on April 27, 2018. The patient takes Suboxone, a medicine that contains buprenorphine and naloxone, to treat his substance use disorder. He said he had been addicted to Opioids for 10 years but has been drug free since he started taking Suboxone nearly 2 years ago.  (Photo by Craig F. Walker/The Boston Globe via Getty Images)
Dr. Laura Kehoe talks to a patient during his appointment as Mass. General Hospital in Boston on April 27, 2018. (Photo by Craig F. Walker/The Boston Globe via Getty Images)

Stein cited a study which revealed that some primary care physicians held biased beliefs about treating people with drug and alcohol problems generally.

“The stigma is still there,” Stein told Yahoo Finance. “Some of it is probably related to the fact that we probably don’t do as good a job of educating health care professionals when they’re in training about the treatment of these disorders as we should. That’s something that we’re really trying to change.”

There also seems to be a racial element: A JAMA Psychiatry study found that Black patients with substance use disorder are significantly less likely to be prescribed buprenorphine than white patients. Another study found that among nonfatal overdoses, Black patients were half as likely to gain follow-up treatment compared to their white counterparts.

Nevertheless, despite the challenges in terms of expanding MAT usage, Stein referred to MAT as "the gold standard" for opioid-related substance use disorders. 

“There are certainly people who can do well without medication for opioid use disorder," Stein said. "But if it was my brother or my sister or my father or my child, the data around medication treatment for opioid use disorder clearly suggests that [MAT is] the most effective thing that we have.”

Adriana Belmonte is a reporter and editor covering politics and health care policy for Yahoo Finance. You can follow her on Twitter @adrianambellsand reach her at adriana@yahoofinance.com.

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